Tuesday - Male Reproductive Path - Twomey Flashcards
Acute bacterial Prostatitis
gram -, same as UTI
sx - fever chills dysuria
Chronic bacterial prosatitis
same organisms but non-specific sx
low back pain, dysuria, pelvic pain
may have UTI’s
Dx - prostate massage –> culture fluid
Most common form of protatitis
chronic abacrterial
- probz just culture (-) bugs
labs with prostatitis
increase PSA
- 30% acually decrease
abx and nsaid may be ineffective
Who gets BPH
old dudes. 70% of 60y/o
50% become symptomatic
Cause of BPH
androgens - DHtestosterone increases with age
estrogen - estradiol levels increase with age –> induce more androgen receptors
Sx of BPH
you have to pee at night more
hard to pee when you start
small stream
dribbling
Complications of BPH
Obstruction - urgent
incomplete emptying
Infection
Infarction
renal failure
Tx for PBH
5 alpha reductase inhibitor - reduces DHT - 50% reduction of PSA alpha 1 blocker - relax smooth muscle TURP, cryotherapy, laser, ultrasound
most common side of vericocele
left side, becaase in goes into the left renal vein (smaller calliber = higher resistance)
- right –> goes to IVC
Testicular descent phases, contraolled by:
phase 1 - transabdominal - controlled by mullarian inhibiting substance
phase 2 - inguinosacral - controlled by androgens
How many people have Cryptorchid
25% if prmature
4-6% patent - closes in 3 months
1-2% after first year
it’s usually unilateral
if cryptorchid is uncorrected:
sterile if bilateral
infertile if unilateral
can lead to hernia
oncogenic!
Treatment of cryptorchid
orchiopexy
do it before 2 years to be fertile, 10 years to prevent cancer
Infertility with oligospermia
less than 20 mill sperm /mL testicular post testicular - obstruction - normal biopsy - may have no vas deferens if Cycstic fibrosis 40% idioparthic
Epididamo-Orchitis
bacterial - same bugs as UTI - sti's granulomatous - TB, fungi (crypto) viral - mumps!
Tortion is usually art or vein?
what happens if you don’t repair it in time
Vein
- before 30 yo
need surgical repair within 4 hours - or hemorrhagic infarct
Vericocele how common?
25% of adults
more common of left
can cause infertility
Testicular neoplasms two classes
germ cell tumors - most common in denmark - seminoma (he puts this in a seprate category, but it's here in FA) - yolk sac - choriocarcinoma - teratoma - embryonal carcinoma sex cord stromal tumors - sertoli, leydig, lymphoma
precursor to neoplasia in germ cells
other factors that increase risk
Intratubular germ cell neoplasia
low % in blacks
high % in kleinfelters
Seminoma
50% of germ cell tumors most common in 30's homogenius (fish flesh) look. waterly cytoplasm can have syncytiatrophoblasts (normally in placenta) - secrete hCG cross crossing fibrosis
Embryonal Carcinoma
2nd most common - usually in 20’s, bad prognosis
have dark hemorrhages, looks worse that seminoma.
looks pretty pleomorphic
yolk sac tumor
usually in infants. under 3 yo
homogeneuus, but yellow looking. looks like glomerulus
Schiller-Duval bodies
Choriocarcinoma
always has beta-hCG
real bad
small
metastisizes to lungs and brain
